Management

Early-stage, discrete thymic tumours should be managed by an experienced thoracic surgeon.

Locally advanced and metastatic thymic malignancies should be managed by a multidisciplinary team comprising medical oncologists, thoracic surgeons, radiation oncologists, pathologists, and radiologists.

Patients with myasthenia gravis should have a formal neurological evaluation.

Note:

• thoracotomy may be considered for diagnosis and removal
• radiotherapy may be indicated for the primary tumour or for any tumour residue - this may be curative in neuroblastoma and thymoma; it may achieve long-term control in malignant teratoma
• combination chemotherapy may be required for neuroblastoma
• treatment with radiotherapy may cause dysphagia and an irritant cough during and immediately after treatment. Occasionally there may be later symptoms of pulmonary fibrosis and pericardial fibrosis.

Reference

1. Girard N, Ruffini E, Marx A, et al. Thymic epithelial tumours: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2015;26(suppl 5):v40-v55.